I love to read. At a young age, I discovered the city library and was a frequent visitor. I started collecting books in elementary school, and at one point I probably had more than 5,000 books in my collection. So I grew up reading, and every chance I get I like to pick up a new book, which is almost weekly. That said, I m surprised to find that almost 20 percent of young people attending college today have a hard time reading or understanding what they read. In many cases, they have only basic literacy skills, which in turn affects their critical thinking skills. What s my point? Some of these students may soon be applying for a job with your organization.

Many EMS schools are mandated to meet state or national standard pass rates for each class of students produced. The pressure of these mandates may lead schools to teach students how to take the test without teaching critical thinking skills. Often, the EMS students who struggle in class are those who struggle with reading and math, a problem that may carry over into their careers.

The next step after passing these tests is for the student to meet the standards of a recruiting organization. Many agencies have some assessment of a candidate s ability to work as an EMT or a paramedic. Some give written examinations with multiple-choice answers while others may have assessment stations for practical skills. But I wonder: Does anyone test for literacy and comprehension skills, including reading, math or critical thinking?

As a provider, how did you learn critical thinking skills? Do you rely on those skills in order to effectively treat a difficult injury or illness with best patient care principles and practices?

As an employer, have you ever had an employee who struggled with new patient care concepts or training that involved a significant amount of reading and studying to become proficient? If so, did you consider that they possibly had a reading or comprehension problem?

These requirements and potential obstacles point to the importance of fully assessing candidates for employment beyond just an oral interview or standard multiple choice test. Some candidates are able to get through EMS training by memorizing expected answers but they may later have a hard time with true problem solving.

Critical thinking skills are important, and we want our EMTs and paramedics to use them when caring for patients. They must be able to apply learned principles and practices in appropriate situations in dealing with emergencies. Even the most experienced provider will occasionally have a case that challenges them to use all their critical thinking skills to effectively manage the incident.

Employees learn both good and bad habits about patient care from the providers who manage them. Rules and regulations determine our performance and develop our experiences. In some cases, education broadens our decision making. But is this the only way to learn how to apply critical thinking skills to our actions at work?

I imagine that some readers would argue that experience in the field is what builds critical thinking skills, and I would agree with that to some extent. But in most agencies, it s not the best solution to just rely on experience to develop employee critical thinking skills. Most agencies also expect employees to be able to be trained via an on-going basis to help develop their patient care abilities and critical thinking abilities.

So how can you help your employees develop critical thinking skills? The following are some suggestions:

Provide current EMS publications to your organization. Develop a library that provides up-to-date monthly journals available for employees to read. Create a learning environment that encourages your employees to stay current with EMS literature and stimulates their desire for constant learning.

Discuss articles or incidents during a training session. Consider assigning employees to research one article or topic per year and to present it for discussion and/or debate on a rotating basis. With a library of current publications, your employees can be easily draw from recent magazine articles or reports on the Internet.

Conduct case study reviews so that members of your organization can discuss EMS calls and patient care delivery. Using an educational method, discuss the patient assessment findings and actions appropriate for treatment of the illness or injury. These can be actual calls from your agency or studies from textbooks or magazines.

Develop monthly practice drills that involve more than just the application or action of practicing EMS skills. Prepare scenarios that require employees to conduct detailed patient assessments and complex skills delivery. For example, it s one thing to apply a traction splint in the middle of a football field with as much room as you need, but it s another to determine what actions are needed when you must apply that same traction splint to someone at the bottom of a set of basement steps in a small area where only one or two people fit easily.

Encourage attendance to local, regional, state or national EMS conferences. Give your employees the opportunity to hear a training topic or presentation from a different source. In some cases, these presentations will deliver valuable information from the leading experts and help develop their critical thinking skills.

Don t limit your expanded training to just patient care skills. Throw in some ethical, legal or moral situations that further challenge their thinking and reasoning, and let them debate those situations. Encourage questions from those employees who challenge the status quo in an effort to deliver a higher level of service. Questions and discussions create an opportunity for analytical thinking to develop further.